P - 79213REQUEST FOR ELECTRICAL INSPECTION
�� 1� V- 5 3 5� Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
. (651) 642-0800 TlY/MRS 1-800�27-3529 www.electriciry.state.mn.us
❑ REMODEL ❑ ADDIT�ON ❑ REPAIR Describe -usin the back of the white copy if necessary - the work covered by this request:
XGEL ENERGY SAVE�'S S�MTCH
✓ICES I POWER
0 to 400 Ampere
401 to 800 Amoe
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
to 12 Units @ $50
ach Additional Unit
Mile
\Y BE
IIII Ilill IIIII IIIII Illltalll IIII IIIN �i�i ili�i
1 7 6� 5 3 5 5
Trafic Signal Standard @ $
Supplemental Fee @ $20
Transformers up to 10 KVA
Transformers over 10 KVA
� Transfortner I Power Supply for Signs I Outline Ligh6ng �$5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspec6on Trips Each Dweliing Unit �$80
(minimum total fee is $20) 20.50
iH15 ARFA FOR INSPECTOR USE OlLY
I hereby certify that I inspected Me elecOrical installaGOn described herein on Me dates stffied:
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nequesi uace: Rough�n Inspection Required? LJ Yes LJT10 Inspection Other TT�an Rough-In: ❑Ready Now ❑ Will Call
�7��� You must call the inspectw when ready! pffie Ready:
I certify that I am fhe ❑XICENSED CONtRACTOR 0 COMPANY ❑ OWNER and hereby request inspection of the electrir.al wak at:
INS7RUC710N8 ON BACK OF YELLOW COpy BOqRp OF ELECTRICITY CAPY EB-00001M71 8.7. 2002